The Cost of Long ED Wait Times

By Austin Frakt, PhD
October 23, 2020

While the pandemic may have dissuaded some people from using the emergency department, perhaps out of fear it could be a hotbed of coronavirus, the longer term trend is toward more people using the ED leading to long wait times.  

Though only a minority of patients wait hours in the ED, long waits can still be problematic, with serious health consequences. Many studies and systematic reviews have found poorer health outcomes and increased mortality associated with longer ED waits. 
A recent study found that longer ED waits not only increase mortality, but costs as well. In a study published last year in Economic Inquiry, Lindsey Woodworth and James F. Holmes exploited the fact that ED triage nurses assign similar patients different “triage levels,” which determine how quickly they will be seen. This inserts a degree of randomness into patient wait times, akin to a coin flip that either speeds up or slows down the ED waits of very similar patients. Without exploiting this natural experiment, one is likely to find that patients who wait longer in the ED do better and cost less because, on average, sicker patients are treated first. Instead, the study found that a 10 minute longer ED wait increases the cost to care for the most critical patients by an average of 6%, and 3% for moderately critical patients.
While important on their own, these results also connect to broader problems in the health care system. A major driver of crowding is the inability of EDs to discharge patients due to a lack of available hospital beds elsewhere, especially for psychiatric care and substance use disorder treatment. If we invested in increasing the supply of these types of beds, we could speed up ED care, and in doing so, improve ED outcomes and reduce costs for everyone.

Austin Frakt is a health economist and director of the Partnered Evidence-based Policy Resource Center at the Boston VA Healthcare System. He’s also a professor of Health Law, Policy and Management at the Boston University School of Public Health, a senior research scientist at the Harvard T.H. Chan School of Public Health, co-editor-in-chief of the health policy blog The Incidental Economist and a regular contributor to the New York Times.

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